Bright School - Mini Medical Form

  • Bright School - Mini Medical Form

  • All students are required to submit completed health forms, including an updated physical form and full immunization record (including Tuberculosis screening with testing if applicable), which demonstrates proof of required immunizations and is signed by the student's health care provider. Parents/Guardians are expected to access all of the medical forms below in the student's SchoolAdmin portal, have them completely fill them out, and upload them back into their portals in the appropriate tabs.

    No student will be permitted to move onto campus or participate in any school activities/sports until all of the required forms are uploaded into SchoolAdmin.

  • Student Health Information

    To be filled out by parent/guardian.
  • Date of Birth*
     - -
  • Any Health Concerns*
  • Prior Surgery*
  • Hospitalizations*
  • Allergies to Medicine*
  • Allergies to Food/Latex/Bee’s etc.*
  • Ever treated for severe allergic reaction or anaphylaxis*
  • Any daily medications (prescription and non-prescription)*
  • Glasses or Contacts*
  • Hearing Problems*
  • Speech Problems*
  • Dental Problems (braces, caps, bridges etc.)*
  • Bleeding Issues/Anemia*
  • Heart Problems*
  • Religious/Cultural Beliefs*
  • Family History of adverse reaction to anesthesia*
  • Artificial implants or metal in the body*
  • Breathing problems or chronic cough*
  • Smoker*
  • Asthma History*
  • Any Problems Running*
  • Muscle or joint injuries*
  • Broken bones /dislocations*
  • Neck or back injuries*
  • Concussion treatment*
  • Ever Fainted or blacked out*
  • Migraines or chronic headaches*
  • Any behavioral issues*
  • Anxiety, depression or mental illness*
  • ADD / ADHD*
  • Psychiatric treatment or counseling*
  • Any family history of unexplained sudden death (prior to age 50)*
  • Any medical treatment/hospitalizations in the past year*
  • Does your child take any prescription or non-prescription medications*

  • I give permission for the release and exchange of information on this form between PSA Health Center and health care providers for confidential use in meeting my child’s health and educational needs.

  • Health Insurance

  • All students are required to have health insurance coverage and provide current copies of insurance cards. International students who will require Health Insurance are to contact the Admissions Department as soon as possible. Any medical expenses not covered by a student’s insurance plan, including co-payments, provider charges, prescription/medication expenses, immunizations, lab fees, and/or medical supplies, and out-of-network costs, must be billed directly to the parent at the home address. In some cases, students may be required to pay co-pay, medication costs, and any other medical expenses directly to the provider at the time of service.

    I have read all of the above information and understand that it is my responsibility to provide all necessary documents PRIOR to my child arriving on campus in August.

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